Healthcare Provider Details

I. General information

NPI: 1437587870
Provider Name (Legal Business Name): MAURA WHITE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S MAIN ST
BLUFFTON IN
46714-2503
US

IV. Provider business mailing address

500 N NAPPANEE ST STE 11-B
ELKHART IN
46514-1503
US

V. Phone/Fax

Practice location:
  • Phone: 260-824-3210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28212235A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: